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The 5th is historically a very safe seat for the Democratic Party, due almost entirely to the influence of heavily Democratic Nashville. Some pockets of Republican influence exist in Belle Meade, and portions of neighboring Cheatham county undergoing rapid suburbanization. However, they are no match for the overwhelming Democratic trend in most of Nashville. While Republicans made several strong bids for the district in the late 1960s and early 1970s (largely over racial issues such as a 1971 busing order), they have only put up token candidates since 1972.

Demographics are a major factor behind the Democrats' near-absolute dominance of the political scene. Many conservative white voters (including Nashville natives) have increasingly moved out of Metro Nashville/Davidson County to more Republican suburban counties such as Williamson and Sumner. They have been replaced largely by liberal-oriented constituencies such as students (and alumni) of the Nashville area's several colleges and universities, music industry professionals, and white-collar professionals, in a manner similar to that of cities such as Atlanta, Houston, Charlotte, Raleigh/Durham, and Austin. In the entire state, only Memphis has a comparable constituency of liberal-minded whites. The clout of Nashville's African-American electorate, a traditionally Democratic constituency, has grown steadily in recent years as well.

Although the district's Cook Partisan Voting Index of D+5 suggests a marginally Democratic district, Davidson County has more people than the rest of the district combined. For this reason, the 5th is one of two seats in Tennessee that are usually not seriously contested by Republicans (the other being the 9th district).

Tennessee has had at least five congressional districts since 1827. The district's current configuration dates from 1953, when Tennessee lost a seat in redistricting. The Tennessee General Assembly shifted most of the territory of the former 6th District to neighboring districts, creating a 5th District located entirely in Davidson County. While other areas around Nashville have been added in subsequent years, the 5th has been drawn as a Nashville-based district ever since.

Below are the counties included in Tennessee District 5 from 1923 to 2013: